Dr. Laura Reigada respects the complex relationship between your brain and your stomach
DGBI is a relatively new acronym so many people may not be all that familiar with this term (even some doctors!). It stands for “disorder of brain-gut interaction,” and it’s used to describe and classify chronic gastrointestinal conditions. Previously these chronic gastrointestinal conditions were known as “functional” disorders, however this phrasing is no longer used. The new classification acknowledges the fact that your mind and gut are closely related and in constant communication.. When this communication system gets disrupted, physical symptoms like abdominal pain, constipation, and/or diarrhea can occur. Many modern treatments are designed to restore the gut-brain communication system, which in turn, improves symptoms.
Based on the ROME IV classification, there are 33 DGBIs which includes bowel disorders (e.g., irritable bowel syndrome), esophageal disorders (e.g., reflux hypersensitivity), gastroduodenal disorders (e.g., functional dyspepsia, belching disorders), centrally mediated disorders of pain, gall bladder and sphincter of Oddi disorders, and anorectal disorders.
How do doctors determine if you have a DGBI like IBS or GERD? Chronic gut conditions are quite common (more than 1 in 10 people have one), with clear symptom clusters that provide a strong indication that a DGBI is the root issue. Your doctor first considers the symptoms you’re experiencing, uses tests like colonoscopies, to rule out other medical conditions, and then can diagnose you with a DGBI based on test results. Sort of like the process of elimination.
So what symptoms are associated with a DGBI, and how are the gut and mind connected exactly? Let’s take a closer look.
Symptoms of DGBI can occur anywhere along the gastrointestinal tract from the top (esophagus) to the bottom (rectum). Each area along the digestive tract has specific roles in digestion and may elicit varying bodily sensitivities, however, there are common features across DGBI. They include:
Motility refers to how fast or slow content moves through the gastrointestinal tract. DGBI symptoms include diarrhea, constipation, spasms, difficulty swallowing, burping, bloating and feeling full quickly when eating to name a few examples. These symptoms are chronic, persisting for many months and even years, which can really impact quality of life.
Gastrointestinal Sensation Sensitivity
People with DGBIs feel pain or experience bodily discomfort despite assurances by their doctor that their gastrointestinal tract appears healthy based on medical tests. While this may seem confusing, the short answer is that although the body looks normal, it is not behaving normally.
What we know is that DGBI pain can be a response of the nervous system overreacting to normal sensations in the gastrointestinal tract, so that normal day-to-day movement and pressure during digestion is experienced as painful. This is why someone can have average levels of gas in the intestines or typical muscle contractions of the colon but can still experience intense pain.
This type of gastrointestinal pain is called visceral hypersensitivity. Your doctor may use this term, it refers to experiencing increased pain or discomfort inside the body despite having intestines that seem to be in good condition. The pain is real, but there is no damage to the body.
Like I mentioned before, our brain and our gut are constantly communicating back and forth with each other. When these communication channels get disrupted or out of sync, it can lead to DGBI conditions.
Of note, the same communication channels that are used for the gut and brain to coordinate digestion are also used to communicate emotions and bodily sensations (among other things). Because all of these signals are using the same network to travel to and from the brain, and at times have overlapping functions, physical and emotional signals can get mixed up, interact with each other and even get amplified.
The channels through which the gut and brain communicate is also how stress can impact gastrointestinal symptoms too!
Our gut is highly susceptible to emotions. Have you ever felt butterflies in your stomach or even nauseous when nervous? The emotions we feel can also directly influence digestion through the gut-brain highway. We’ve all likely experienced stressful work weeks or unexpected family emergencies that impacted your digestion and made you rush to the nearest bathroom because your food made its way through the intestines at hyperspeed.
One reason why this happens is that the body's “fight and flight” response system is activated when anxious to address the real or perceived threat. When this happens, the body diverts resources away from digestion to address the threat. Over time, ongoing and persistent stress can keep the body in a state of alert, and really wreak havoc on the gastrointestinal tract and digestion.Having gastrointestinal symptoms can be very stressful, causing a cyclical pattern.
Studies of the brain show people with IBS interpret digestion sensations differently and in a more threatening manner than people without IBS. These studies confirm that DGBI like IBS lead to increased sensitivity to physical sensations in the gastrointestinal tract. This brain signaling disruption is why folks with IBS pay more and more attention to their physical sensations over time.
This can happen with other DGBIs too. The brain becomes less able to tune out the normal bodily function of digestion, and it’s on high alert like a very sensitive radar detector. Over time, gastrointestinal symptoms can cause anxiety and fear, which is called visceral anxiety. This specific type of anxiety fuels increased attention to physical sensations in the digestive system, causing a cyclical pattern of gastrointestinal symptoms, pain and anxiety.
As you can see, the gut-brain communication system is quite complex. The cross-talk between messages to and from the brain (mind-body connection) and biological processes can overlap and interact in terms of what we experience both physically and emotionally. The good news is that scientists and medical providers know a lot more about how the mind-body connection may contribute to DGBIs.
Salvo Health has a multidisciplinary care model, called Whole Self Science, that was designed by a Clinical Advisory Board of the world’s leading gut experts, including myself. The Salvo Health Care Teams use Whole Self Science to target the brain-gut system to relieve symptoms and optimize well-being. DGBIs can be treated with multiple approaches including medication, brain-gut behavioral therapy, and lifestyle changes. Get immediate access to a coordinated Salvo Health care team, including a certified gastro specialist and board-certified health coach when you join Salvo Health today.
"Regional cerebral activation in irritable bowel syndrome and control subjects with painful and nonpainful rectal distention", Division of Gastroenterology and Biostatistics, Department of Medicine, and Department of Radiology and Radiologic Sciences, Vanderbilt University, Nashville, Tennessee, Available online 27 October 2005, link